Health-Related Quality of Life, Depression and Anxiety in Hospitalized Patients with Tuberculosis
Open accessAbstract
BACKGROUND: Much of the attention of tuberculosis (TB) programs is focused on outcomes of microbiological cure and mortality, and health related quality of life (HRQL) is undervalued. Also, TB patients have a significantly higher risk of developing depression and anxiety compared with those in the general population. We intend to evaluate the HRQL and the prevalence of symptoms of depression and anxiety in hospitalized patients with TB. METHODS: Cross-sectional study in a tertiary care hospital in Brazil. Adult patients with pulmonary TB that were hospitalized during the study period were identified and invited to participate. HRQL was measured using the Medical Outcomes Study Short Form-36 (SF-36) version 2. Hospital Anxiety and Depression Scale (HADS) was used to record symptoms of anxiety and depression. RESULTS: Eighty-six patients were included in the analysis. The mean age of all patients was 44.6±15.4 years, 69.8% were male, and 53.5% were white. Thirty-two patients (37.2%) were human immunodeficiency virus positive. Twenty-seven patients (31.4%) met study criteria for depression (HADS depression score ≥11) and 33 (38.4%) had anxiety (HADS anxiety score ≥11). Scores on all domains of SF-36 were significantly lower than the Brazilian norm scores (p<0.001). CONCLUSION: The present study shows that TB patients may have a poor HRQL. Additionally, we found a possible high prevalence of depression and anxiety in this population. Health care workers should be aware of these psychological disorders to enable a better management of these patients. The treatment of these comorbidities may be associated with better TB outcomes.
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Common mental disorders, especially depression and anxiety, are highly prevalent among people with TB, with estimates often ranging from approximately 40% to 60%, and with an even greater burden among MDR-TB populations.
“There is growing evidence that common mental disorders, especially depression and anxiety, are highly prevalent among people with TB, with estimates often ranging from approximately 40% to 60%, and with an even greater burden among MDR-TB populations [7,8,9].”
From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [8]
The Introduction and Discussion describe depression and anxiety as common among people with TB, and the Results report depression in 31.4% and anxiety in 38.4% of this study’s hospitalized patients. The paper does not establish that estimates often range from 40% to 60%, and the passages found do not report a greater burden among MDR-TB populations (searched: MDR-TB and multidrug-resistant TB). No page numbers were provided in our copy. (LLM, conf=0.88)
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“Dos Santos et al. (2017) reported similar findings among Brazilian TB patients.”
Psychological manifestations in patients with tuberculosis: prevalence and contributing factors
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“Beyond its clinical effects, TB also imposes substantial psychosocial and economic strain, often leading to mental health challenges, stigma, and diminished quality of life (QoL) among affected individuals [6 – 8].”
Srinivas, M., Patil, N. J., Prabhakar, K. R., & Jagmohan, S. V. (2023) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_208_23 · Cited by 2 · see citing works
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Bala, M., Rajpoot, A., Layek, A., Gupta, R. K., & Rathore, S. S. (2025) · Indian Journal of Tuberculosis · doi:10.1016/j.ijtb.2025.03.010 · Cited by 1 · see citing works
Gupta, A. J., Turimumahoro, P., Rosman, L. M., Golub, J. E., & Dowdy, D. W. (2025) · PLoS ONE · doi:10.1371/journal.pone.0322753 · Cited by 1 · see citing works
“This is due to a lack of providers, funding, cultural norms, and stigma [20,22,30,31].”
Anxiety during active TB and enduring post-TB anxiety-related sequelae
Lu, Y., & Hoddinott, G. (2026) · IJTLD OPEN · doi:10.5588/ijtldopen.25.0634 · Cited by 1 · see citing works
“53 studies examined direct associations between TB and anxiety, and 37 explored anxiety alongside other psychological issues.”
Fuady, A., Haya, M. A. N., Anindhita, M., Haniifah, M., Hardy, F. R., Haq, D. F. A., Aliska, I., Febriani, E. R., Rifky, A. F., Karnasih, A., et al. (2026) · PLOS Global Public Health · doi:10.1371/journal.pgph.0006754 · Cited by 1 · see citing works
“Awareness and sensitivity among healthcare workers are especially important to recognize these challenges, facilitate appropriate referrals to counselling or mental health services, and promote empathic patient–provider interactions [33].”
Zhang, M., Huang, N., Hu, B., Chen, C., & Guo, J. (2024) · Current Psychology · doi:10.1007/s12144-024-06696-w · Cited by 1 · see citing works
Application of Listening to Asmaul Husna to Anxiety in Pulmonary Tubercolosis Patients "Case Study"
Nurbaiti, N., Zainuddin, R., Mahmud, Y., Ahmad, E. H., & Lanipo, H. H. (2022) · Journal La Medihealtico · doi:10.37899/journallamedihealtico.v3i5.719 · Cited by 1 · see citing works
Prevalence of Depression in Patients with MDR TB
Jha, P., Mishra, R. K., & Ghildiyal, R. (2018) · Indian Journal of Mental Health(IJMH) · doi:10.30877/ijmh.6.1.2019.82-85
Korelasi Kecemasan dan Domain Kelelahan pada Pasien Tuberkulosis
Tasnim, T., & Lainsamputty, F. (2021) · Klabat Journal of Nursing · doi:10.37771/kjn.v3i1.544
Sari, G. M., Aridamayanti, B. G., Sariati, S., Sholikhah, D. U., Narendri, C. M., & Romadhon, W. A. (2020) · Jurnal Penelitian Kesehatan "SUARA FORIKES" (Journal of Health Research "Forikes Voice") · doi:10.33846/sg11nk115
EVALUATION OF DEPRESSION AND ANXIETY AMONG TUBERCULOSIS PATIENTS
RAZZAQ, M., ATIF, M., ULLAH, U., MEHMOOD, M., & IRFAN, M. (2022) · Biological and Clinical Sciences Research Journal · doi:10.54112/bcsrj.v2022i1.128
“Various studies have reported high prevalence of anxiety and depression in patients with TB (Adem et al., 2013; Duko et al., 2015; Kumar et al., 2016).”
BackgroundGerszt, P. P., Maciel, E. L. N., Daré, I. B., da Silva, T. C. F., Fregona, G. C., Fiorin, B. H., Attianezi, M., & do Prado, T. N. (2022) · Enfermagem em Foco · doi:10.21675/2357-707x.2022.v13.e-202232
Gaylord, I. W. I., Patricia, B. M., Sebastien, E. M., Rachel, A., Ogik, P., Faruck, K., Karuma, F., Pierre, C., Limengo, B., Roger, I. M., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2549830/v1
Comorbilidades y Tuberculosis: Diabetes, Depresión y Enfermedad Renal Crónica
Gil, C. U. (2019) · Diagnóstico · doi:10.33734/diagnostico.v57i4.52
Pellegrini, J. M., Morelli, M. P., Colombo, M. I., & García, V. (2023) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2023.1332084
Yogesh, M., Parmar, D., & Patel, N. S. (2024) · Research Square · doi:10.21203/rs.3.rs-3928726/v1
The Impact on the Quality of Life of Patients with Drug-Resistant Tuberculosis – Brief Review
Butnaru, T., Mihaltan, F. D., & Ancuţa, C. (2024) · Internal Medicine · doi:10.2478/inmed-2024-0289
Minochkin, D. A., & Berezantsev, A. Y. (2024) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2408-01
Tuberculosis and Mental Health
Doherty, A. M., Gunawardena, S. M., & McMahon, E. (2025) · Springer eBooks · doi:10.1007/978-3-031-81802-8_11
The Relationship between Depression/Anxiety and Food Service Satisfaction in Hospitalized Patients
ÖZTÜRK, M. E., & Ayhan, N. Y. (2025) · İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi · doi:10.38079/igusabder.1550218
Ponnuchamy, L., Majhi, G., Shreedevi, A. U., Pandian, D. R., & Prakash, P. (2025) · Cureus · doi:10.7759/cureus.96064
“A poor quality of life and management of comorbid conditions are significant contributors to the acceleration of TB among patient populations [25].”
The Role of Pulmonary Rehabilitation in the Restoration of Respiratory Function After Tuberculosis
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Additional file 1 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590587
Chen, X., Du, L., Wu, R., Xu, J., Ji, H., Zhang, Y., Zhu, X., & Zhou, L. (2021) · Figshare · doi:10.6084/m9.figshare.13520970
Additional file 6 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590602
Additional file 3 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590593
Additional file 2 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590590
Additional file 4 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590596
Additional file 5 of Tuberculosis related disability: a systematic review and meta-analysis
Alene, K. A., Wangdi, K., Colquhoun, S., Chani, K., Islam, T., Rahevar, K., Morishita, F., Byrne, A., Clark, J. M., & Viney, K. A. (2021) · Figshare · doi:10.6084/m9.figshare.16590599
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“However, systematic attempts to estimate the prevalence of anxiety are scarce [18].”
Haile, G. B., Gu, J., Wang, P., Suo, S., Abul, K., Belay, K., & Wang, P. (2026) · Behavioral Medicine · doi:10.1080/08964289.2026.2702955
Impact of isolation and hospitalisation for people with TB
Vavliakis, I., Brummelaar, M. T., Kerstjens, H. A. M., Kroon, K., Bolhuis, M. S., & Akkerman, O. W. (2026) · IJTLD OPEN · doi:10.5588/ijtldopen.26.0100
Patel, M., Lakhtaria, H., Murugan, Y., & Samatbhai, P. H. (2026) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_261_25
- Authors
- Santos, A. P. C. D., Lazzari, T. K., & Silva, D. R.
- Affiliations
- Graduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Universidade Federal do Rio Grande do Sul (BR)
- Corresponding author
- Silva, Denise Rossato
- Venue
- Tuberculosis and Respiratory Diseases
- Published
- 2017
- Volume
- 80
- Issue
- 1
- Pages
- 69
- ISSN
- 0378-0066 (ISSN-L)
- 1738-3536
- 2005-6184
- PMC
- PMC5256348
- OpenAlex
- W2575823451
- Cited by
- 88
- References
- 33
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 14 · 2023: 9 · 2022: 15 · 2021: 15 · 2020: 6 · 2019: 5 · 2018: 4
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Tuberculosis & respiratory diseases (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- ICOHRTA/Fogarty International Center/National Institutes for Health-NIH
- Johns Hopkins Bloomberg School of Public Health
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- tuberculosis, health-related quality of life, depression, anxiety, hospitalized patients, pulmonary tuberculosis, HIV coinfection, psychological comorbidity, SF-36, Hospital Anxiety and Depression Scale
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